Comprehensive Guide to Healthcare Compliance: Authorization, Documentation, and Billing Practices
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This comprehensive guide serves as an essential resource for healthcare professionals navigating the complexities of compliance, authorization, and billing practices. It covers critical aspects including patient demographic information, the 72-hour rule, HIPAA regulations, and accurate documentation required for insurance claims. Dive into the intricacies of medical necessity, coding responsibilities, and charge descriptions while understanding the importance of timely documentation and compliance as a team effort. Stay informed and compliant to mitigate potential fraud and abuse risks.
Comprehensive Guide to Healthcare Compliance: Authorization, Documentation, and Billing Practices
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Presentation Transcript
Authorization/Release Consent Forms ABN Orders LMRP/NCD Registration MSP Questionnaire 72 hour rule HIPAA Patient Demographic Information Insurance Information Pre-certifications
Complete/legible/signatures Proper procedure selection for billing entry system Patient Service Areas Authorization --- Orders Service = Order Documentation = Actual Services Late entries and corrections ABN Support for Medical Necessity LMRP Confidentiality
Charge Description Master CDM Accurate CPT Assignment Accurate Revenue Code Assignment Documentation Bundling / Unbundling Understanding HIM coding responsibility
Health Information Management Documentation Coding of Diagnoses / Procedures Complications/Co-morbidities Physician Queries
Billing Documentation Modifiers CCI Edits 72 Hour Rule Site of Service
Collections Refunds Documentation Timeliness Documentation of Credit Balances Credit Balance Reporting Credit Balances Returned Reasonable Efforts to Collect – Medicare Bad Debts
Summary • Compliance is a Team Effort! • Personal protection • Organizational protection • Individuals can be held responsible for issues of fraud and abuse.
Lesson 4 Medicare Target Areas - Section 2 Health Care Compliance If you have any questions or concerns regarding this course, please contact Cindy Dupree at cdupree@draffin-tucker.com.
